Chronic VIM thalamic stimulation in Parkinson's disease, essential tremor and extra-pyramidal dyskinesias.
Identifieur interne : 001D22 ( Ncbi/Checkpoint ); précédent : 001D21; suivant : 001D23Chronic VIM thalamic stimulation in Parkinson's disease, essential tremor and extra-pyramidal dyskinesias.
Auteurs : A L Benabid [France] ; P. Pollak ; E. Seigneuret ; D. Hoffmann ; E. Gay ; J. PerretSource :
- Acta neurochirurgica. Supplementum ; 1993.
English descriptors
- KwdEn :
- Basal Ganglia Diseases (surgery), Basal Ganglia Diseases (therapy), Electric Stimulation Therapy, Electrodes, Implanted, Female, Humans, Male, Mesencephalon (physiology), Mesencephalon (surgery), Movement Disorders (surgery), Movement Disorders (therapy), Parkinson Disease (surgery), Parkinson Disease (therapy), Stereotaxic Techniques, Thalamus (physiology), Thalamus (surgery), Tremor (surgery), Tremor (therapy).
- MESH :
- physiology : Mesencephalon, Thalamus.
- surgery : Basal Ganglia Diseases, Mesencephalon, Movement Disorders, Parkinson Disease, Thalamus, Tremor.
- therapy : Basal Ganglia Diseases, Movement Disorders, Parkinson Disease, Tremor.
- Electric Stimulation Therapy, Electrodes, Implanted, Female, Humans, Male, Stereotaxic Techniques.
Abstract
Stereotactic thalamotomy of the VIM (ventral intermediate) nucleus is considered as the best neurosurgical treatment for Parkinsonian and essential tremors. However, this surgery, especially when bilateral, still presents a risk of recurrence and neurological complications. We observed that acute VIM stimulation at frequencies higher than 60 Hz during the mapping phase of the target suppressed the tremor of Parkinson's disease (PD) and essential tremor (ET). This effect was immediately reversible at the end of the stimulation. This was initially proposed as an additional treatment for patients already thalamotomized on the contralateral side, and then extended as a regular procedure for extra-pyramidal dyskinesias. Since January 1987, we implanted 126 thalami in 87 patients (61 PD, 13 ET, 13 dyskinesias of various origins). Deep brain stimulation electrodes were stereotactically implanted under local anaesthesia, using stimulation and micro-recording to delineate the best site of stimulation. Electrodes were subsequently connected to implantable programmable stimulators. The optimal frequency was around 130 to 185 Hz. The results (evaluated by a neurologist from 0 = no effect to 4 = perfect relief) are related to the type of tremor. Altogether, 71% of the 80 patients benefited from the procedure with grade 3 and 4 results. In 88% of the PD cases, the results were good (grade 3) or excellent (grade 4) and stable with time. Rigidity was moderately for a long improved but akinesia was not. The same level of improvement was observed in 68% of the ET patients and only in 18% of the other types of dyskinesias.(ABSTRACT TRUNCATED AT 250 WORDS)
PubMed: 8109299
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Chronic VIM thalamic stimulation in Parkinson's disease, essential tremor and extra-pyramidal dyskinesias.</title><author><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A L" last="Benabid">A L Benabid</name><affiliation wicri:level="1"><nlm:affiliation>Department of Neurosciences, INSERM 318, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Neurosciences, INSERM 318</wicri:regionArea><wicri:noRegion>INSERM 318</wicri:noRegion><wicri:noRegion>INSERM 318</wicri:noRegion></affiliation></author><author><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P" last="Pollak">P. Pollak</name></author><author><name sortKey="Seigneuret, E" sort="Seigneuret, E" uniqKey="Seigneuret E" first="E" last="Seigneuret">E. Seigneuret</name></author><author><name sortKey="Hoffmann, D" sort="Hoffmann, D" uniqKey="Hoffmann D" first="D" last="Hoffmann">D. Hoffmann</name></author><author><name sortKey="Gay, E" sort="Gay, E" uniqKey="Gay E" first="E" last="Gay">E. Gay</name></author><author><name sortKey="Perret, J" sort="Perret, J" uniqKey="Perret J" first="J" last="Perret">J. 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Pollak</name></author><author><name sortKey="Seigneuret, E" sort="Seigneuret, E" uniqKey="Seigneuret E" first="E" last="Seigneuret">E. Seigneuret</name></author><author><name sortKey="Hoffmann, D" sort="Hoffmann, D" uniqKey="Hoffmann D" first="D" last="Hoffmann">D. Hoffmann</name></author><author><name sortKey="Gay, E" sort="Gay, E" uniqKey="Gay E" first="E" last="Gay">E. Gay</name></author><author><name sortKey="Perret, J" sort="Perret, J" uniqKey="Perret J" first="J" last="Perret">J. Perret</name></author></analytic><series><title level="j">Acta neurochirurgica. Supplementum</title><imprint><date when="1993" type="published">1993</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Basal Ganglia Diseases (surgery)</term><term>Basal Ganglia Diseases (therapy)</term><term>Electric Stimulation Therapy</term><term>Electrodes, Implanted</term><term>Female</term><term>Humans</term><term>Male</term><term>Mesencephalon (physiology)</term><term>Mesencephalon (surgery)</term><term>Movement Disorders (surgery)</term><term>Movement Disorders (therapy)</term><term>Parkinson Disease (surgery)</term><term>Parkinson Disease (therapy)</term><term>Stereotaxic Techniques</term><term>Thalamus (physiology)</term><term>Thalamus (surgery)</term><term>Tremor (surgery)</term><term>Tremor (therapy)</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Mesencephalon</term><term>Thalamus</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Basal Ganglia Diseases</term><term>Mesencephalon</term><term>Movement Disorders</term><term>Parkinson Disease</term><term>Thalamus</term><term>Tremor</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Basal Ganglia Diseases</term><term>Movement Disorders</term><term>Parkinson Disease</term><term>Tremor</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Electric Stimulation Therapy</term><term>Electrodes, Implanted</term><term>Female</term><term>Humans</term><term>Male</term><term>Stereotaxic Techniques</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Stereotactic thalamotomy of the VIM (ventral intermediate) nucleus is considered as the best neurosurgical treatment for Parkinsonian and essential tremors. However, this surgery, especially when bilateral, still presents a risk of recurrence and neurological complications. We observed that acute VIM stimulation at frequencies higher than 60 Hz during the mapping phase of the target suppressed the tremor of Parkinson's disease (PD) and essential tremor (ET). This effect was immediately reversible at the end of the stimulation. This was initially proposed as an additional treatment for patients already thalamotomized on the contralateral side, and then extended as a regular procedure for extra-pyramidal dyskinesias. Since January 1987, we implanted 126 thalami in 87 patients (61 PD, 13 ET, 13 dyskinesias of various origins). Deep brain stimulation electrodes were stereotactically implanted under local anaesthesia, using stimulation and micro-recording to delineate the best site of stimulation. Electrodes were subsequently connected to implantable programmable stimulators. The optimal frequency was around 130 to 185 Hz. The results (evaluated by a neurologist from 0 = no effect to 4 = perfect relief) are related to the type of tremor. Altogether, 71% of the 80 patients benefited from the procedure with grade 3 and 4 results. In 88% of the PD cases, the results were good (grade 3) or excellent (grade 4) and stable with time. Rigidity was moderately for a long improved but akinesia was not. The same level of improvement was observed in 68% of the ET patients and only in 18% of the other types of dyskinesias.(ABSTRACT TRUNCATED AT 250 WORDS)</div></front></TEI><affiliations><list><country><li>France</li></country></list><tree><noCountry><name sortKey="Gay, E" sort="Gay, E" uniqKey="Gay E" first="E" last="Gay">E. Gay</name><name sortKey="Hoffmann, D" sort="Hoffmann, D" uniqKey="Hoffmann D" first="D" last="Hoffmann">D. Hoffmann</name><name sortKey="Perret, J" sort="Perret, J" uniqKey="Perret J" first="J" last="Perret">J. Perret</name><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P" last="Pollak">P. Pollak</name><name sortKey="Seigneuret, E" sort="Seigneuret, E" uniqKey="Seigneuret E" first="E" last="Seigneuret">E. Seigneuret</name></noCountry><country name="France"><noRegion><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A L" last="Benabid">A L Benabid</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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